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Period Acne: How Your Menstrual Cycle Causes Acne

Do you find yourself always breaking out right before your period? Does your looming period always make you dread the period-acne attack? Are you sick of breaking out every single month and not knowing why or how to fix it?

I hear you. I’ve been there. The frustration is real!

For years I was so frustrated about why my skin would fluctuate during the month – how it could be amazing some parts and then randomly break-out in others. It wasn’t until I understood the full hormonal eb and flow women experience over an average 28-day cycle, that I realised how our menstrual cycle influences our skin and acne.

If you don’t want to get into the nitty gritty of the cycle (though who wouldn’t want to know about the inner workings of our incredible body), skip to the tl:dr section at the end of this post so you can get straight to the practical tips. If not, read on my empowered, cyclical woman.

Menstrual Cycle 101

Your menstrual cycle is not just “on your period” vs “not on your period” – it is actually comprised of 4 different phases. Each phase has distinct hormonal fluctuations that can impact how your skin functions. We’re going to go through each phase super briefly, so you don’t get bored with the nerdy facts.

Phase 1: Period or Menstruation

Duration: 5 to 6 days on average (can last up to 8)

This phase doesn’t need an introduction – go get the tampons, hot water bottle, a block of chocolate and turn on The Notebook cause you just got your period. The period is actually day 1 of the cycle. This is when the uterus contracts and sheds its lining after a pregnancy hasn’t occurred. And while you’re drinking your tea with a side of ibuprofen, behind the scenes, your hormones are preparing for pregnancy…again.

Hormonal Players: Estrogen and Progesterone have bottomed out and are at their lowest concentration. However, your estrogen starts to rise towards the end of your period to reform the lining of the uterus (see follicular phase).

Phase 2: Follicular Phase

Duration: 7 to 10 days on average (if counting from end of period to ovulation)

This phase technically begins from the first day of your period until ovulation, but for ease I like to separate it into 2 distinct phases. The body is starting to prepare the uterus and begins to mature the follicles (the sac that contains the egg) inside the ovaries.

Hormonal Players: Follicle stimulating hormone is released to do just that – stimulate the maturation of follicles. Estrogen is queen here – she’s dominant and in charge. Her levels are slowly rising to prepare the lining of the uterus for egg implantation.

Phase 3: Ovulatory Phase

Duration: 3 to 4 days on average. Note – ovulation only occurs on one day during this phase.

Ovulation is when the egg is released into the fallopian tube. It’s now ready for implantation – cue the baby making. This is the please-don’t-happen-to-me phase for all my sexually active, not-wanting-a-baby folks.

Hormonal Players: There is a dramatic rise in estrogen and a rise in luteinising hormone which peaks causing the release of the egg. There is also a sharp surge and decline of testosterone during this phase increasing your libido – your hormones way of telling you to have sex NOW! Progesterone increases slightly (but its time in the spotlight is during the next phase).

Phase 4: Luteal Phase

Duration: 10 to 14 days on average

This phase occurs from ovulation until the start of your next period. This is where the lining of your uterus is preparing for pregnancy. If pregnancy doesn’t occur, the egg that has travelled to the uterus will begin to break down and the lining of the uterus sheds – which starts the period and the menstrual cycle repeats.

Hormonal Players: Now it’s progesterone’s time to shine in this phase– it continues to rise and takes over from estrogen to become the dominant hormone. Progesterone is released to maintain the thickened lining of the uterus that estrogen has worked so hard to produce and prepare for pregnancy. Estrogen that did drop off at ovulation rises again. There is also a slight rise in testosterone in this half of the cycle compared to the first half. If pregnancy doesn’t occur, both estrogen and progesterone levels drop off towards the end of the cycle.

Hormonal fluctuations of the menstrual cycle (featuring estrogen, progesterone and testosterone)

How Does the Menstrual Cycle Affect Acne?

To make it clearer to understand how the menstrual cycle can cause acne, lets breakdown the stereotypical skin changes that can occur during each phase.

Follicular Phase: Generally speaking, your skin is going to experience less breakouts and is actually going to look pretty amazing. This is because estrogen is slowly starting to increase during this phase and when it’s in balanced levels, estrogen is amazing for the skin’s elasticity, hydration, collagen production and supporting the skins barrier.

Your estrogen peaks right before ovulation so it’s time to book in your important social events and that date with the guy you matched with on bumble, cause your skin is going to be looking on point, girl 😉

Ovulation: Things can go a bit iffy here for some people because there’s a lot happening hormonally.

Estrogen peaks pre-ovulation and then dramatically drops and progesterone has risen slightly. If there is an imbalance in the optimal ratio of estrogen to progesterone (also known as estrogen dominance) it can result in breakouts around ovulation. Higher estrogen ratios compared to normal can also cause increased inflammation in the body which also attributes to acne.

Additionally, the rise in testosterone and other androgens (male hormones) during ovulation causes an increase in the skins oil (known as sebum) which can also result in the formation of acne.

Luteal Phase: There are many theories as to why women experience breakouts in this phase, especially in the week leading up to your period.

At the start of the luteal phase progesterone is meant to be the dominant hormone. Acne can arise if there’s estrogen dominance, which as we mentioned before, is more estrogen compared to progesterone. This is because progesterone, in normal levels, blocks the formation of a supercharged version of testosterone, known as dihydrotestosterone, which can increase the production of sebum 10-fold. So, a lower ratio of progesterone to estrogen can result in more sebum and yes acne.

Though the effects of progesterone are still under debate, some studies also suggest that an excess of progesterone can compress pores and also trigger sebum production creating a perfect environment to trap acne-causing bacteria in the pores. So if progesterone is in excess it could also potentially trigger acne. Hormonal balance is key.

Ever get those pimples right before your period? Here’s why: right before your period, your estrogen and progesterone levels begin to drop dramatically. Now there is a higher ratio of testosterone compared to estrogen/progesterone so it’s androgenic affects become more prominent without the other two hormones counterbalancing it. This means that testosterone (and other androgens) produces more sebum and results in those pre-menstural breakouts.

Menstruation:Your skin during your period can sometimes appear dry, and dull because of the low levels of estrogen. Additionally, the release of prostaglandins, which are chemicals released to trigger the uterus muscles to contract, creates more skin sensitivity during this time

Unlike PMS symptoms, which can leave as your period starts, acne can still persist on your period (haven’t we had enough?!). This is because when estrogen and progesterone levels are at their lowest, the androgenic effects of testosterone can come shining through: increased sebum, inflammation and acne.

You can read a more in depth version of how each hormone causes acne HERE.

tl;dr: Top Tips to Prevent Menstrual cycle acne

  • Support Estrogen Clearance:  To prevent estrogen dominance, we want to ensure we are effectively eliminating and detoxing estrogen (and other hormones) from the body, so it’s not reabsorbed. This includes:
    • Ensuring you are pooping at least once a day
    • In the second phase of your cycle, try reducing phytoestrogens in your diet (if you’re consuming a lot). This includes things like soy products, sesame seeds/tahini or flaxseeds which have been suggested to cause an increase in estrogen levels (though research is still under debate). As well as reducing exposure to endocrine disrupters (e.g fragrances, BPA, pesticides) that mimic the natural estrogen in our body.
    • Supporting your body with supplements if required (liver support and estrogen clearers like: Diindolylmethane aka DIM). Note that it’s important to work out what’s going on hormonally for your individual body with the help of a practitioner, you don’t want to be blindly taking supplements to work on estrogen clearance when testosterone excess is your problem as an example. Test it, don’t guess it.
  • Remove Pore Clogging Ingredients: If you have pore clogging ingredients in your skincare that is already blocking your pores, when you get hormonal fluctuations during the cycle (especially ovulation and pre-period), it is just going to cause the pore to become more clogged and inflamed. Sometimes by just removing pore clogging ingredients from your products you’ll see a reduction in hormonal acne.
  • Diet: To maintain hormonal health, overall we want to be eating a wholefood, minimally processed diet with an abundance of plants, healthy fats and high quality proteins. This will ensure that you are maximising your gut health and balancing your hormones. General hormone balancing (and skin-loving) foods include:
    • Dark leafy greens
    • Cruciferous vegetables – kale, cauliflower, brussels sprouts, broccoli, cabbage (helps support the liver and clear estrogen)
    • Foods high in omega 3’s – walnuts, chia seeds, fatty fish (salmon, sardines, mackerel).Good quality healthy fats – avocadoes, coconut oil, extra virgin olive oil.
    • Probiotics –fermented foods are high in probiotics that support your gut with bacterial strains. This includes things like fermented veges, sauerkraut, miso, kimichi, yoghurts (preferable to be dairy-free for acne). Note to slowly introduce these foods into your diet as overloading can cause issues if you have a gut imbalance or histamine intolerance.
    • Foods rich in B-vitamins: liver, sweet potatoes, eggs, sunflower seeds, fatty fish, leafy greens.Liver – this is like the food version of a multivitamin (I can feel you turning up your nose at this one right now)
    • Avoid foods like dairy and high glycemic index foods such as high sugar products that can impact your hormones levels and trigger acne.

I know this seemed like a lot of information, but this is just scratching the surface of our menstrual cycle. In order to biohack our hormones and our skin, we need to be able to work with the power of our menstrual cycle in the way we eat, exercise, work and play (yes that means sex too) during different parts of our cycle. By balancing our hormones and our cycle we are able to have more energy, less PMS, and have clearer skin throughout the cycle.

P.S Watch this space: a menstrual cycle and acne mini-course might be on its way in the near future so you know what to eat, how to exercise and what to plan during each different phase of the cycle. Get ready to level up your hormones and your skin.

Now I want to hear from you! Have you noticed changes in our skin throughout the month? Have you tried any menstrual cycle hacks to help keep your skin glowing throughout the month?

Let me know your biggest takeaways – leave a comment below or send me a message over on Instagram.

Sending love,

References

Elsaie ML. Hormonal treatment of acne vulgaris: an updateClin Cosmet Investig Dermatol. 2016 Sep 2;9:241-8. doi: 10.2147/CCID.S114830

Hermanns-Lê T, Hermanns JF, Lesuisse M, Piérard GE. Cyclic catamenial dermatoses. Biomed Res Int. 2013;2013:156459. doi: 10.1155/2013/156459. Epub 2013 Oct 2. PMID: 24199187; PMCID: PMC3807835.

Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. [Updated 2018 Aug 5]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-Available from: https://www.ncbi.nlm.nih.gov/books/NBK279054/

Skiba MA, Bell RJ, Islam RM, Handelsman DJ, Desai R, Davis SR. Androgens During the Reproductive Years: What Is Normal for Women? J Clin Endocrinol Metab. 2019 Nov 1;104(11):5382-5392. doi: 10.1210/jc.2019-01357. PMID: 31390028.: https://pubmed.ncbi.nlm.nih.gov/31390028/

Steinberger E, Rodriguez-Rigau LJ, Smith KD, Held B. The menstrual cycle and plasma testosterone levels in women with acne. J Am Acad Dermatol. 1981 Jan;4(1):54-8. doi: 10.1016/s0190-9622(81)70008-2. PMID: 6451638.

Shah MG, Maibach HI. Estrogen and skin. An overview. Am J Clin Dermatol. 2001;2(3):143-50. doi: 10.2165/00128071-200102030-00003. PMID: 11705091. 

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